POS0790-HPR THE EFFECT OF A GOAL SETTING STRATEGY WITH INTEGRATED FEEDBACK ON GOAL ATTAINMENT IN INFLAMMATORY ARTHRITIS PATIENTS: A MIXED METHOD STUDY
Authors: K. Van Slingerland, P. De Jong, R. Dolhain, A. Pasma
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Healthcare is increasingly shifting towards a person-centered care(PCC) approach. Unfortunately, in daily practice, outpatient consultations focus mainly on medical topics, ignoring the impact of the disease on daily life. To understand the impact on patients' daily lives, Patient Reported Outcomes(PROs) can be used. However, it is not enough to only use PROs when offering PCC, because the patient's true values and goals can only be ascertained during a good conversation, in which both medical and patient goals should be addressed. <h3>Objectives</h3> The aim of this study is to evaluate the effect of a goal management strategy with integrated feedback on goal attainment and Health-Related Quality of Life(HRQoL) in inflammatory arthritis(IA) patients. We also explored what type of goals were set. <h3>Methods</h3> Data were used from the Immune Mediate Inflammatory Disease(IMID) registry, a prospective cohort study in which IMID patients were followed with online PRO questionnaires. IA patients with active disease were asked to formulate up to 3 achievable goals within 3 months of follow-up. They could work independently on their goals. Every 2 weeks, patients received an automatically generated e-mail reminder asking them how well they had worked on their goals for the previous 2 weeks. After 3 and 6 months, it was evaluated whether the goals were achieved. If the goals were achieved after 3 months, new goals could be formulated for the next 3 months. Patients' goals were classified into the 14 domains of the Self-management Web, extended with the domains pain and energy. At each visit (baseline, 3 and 6 months) patients also filled out online questionnaires on goal setting, shared decision making(SDM) and PROs. PRO questionnaires included HRQoL, patient satisfaction(VAS-PS), pain(VAS-pain), general health(VAS-GH) and daily functioning(HAQ). At baseline also a questionnaire on coping styles was filled out. <h3>Results</h3> Ninety-two patients participated in the study. The mean age was 51 years and the most common diagnosis was rheumatoid arthritis. A total of 302 patient goals were set, of which 32% were achieved. Most goals were formulated in the domains lifestyle(14%), pain(13%) and symptoms &amp; side-effects(13%). Fewer goals were formulated in the domains intimate relationships &amp; sexuality(0.6%) and finances(0.3%). In the entire population, HRQoL, VAS-PS, VAS-pain, VAS-GH and HAQ scores did not change over time. However IA patients who did not achieve their goals tended to score worse on HRQoL, VAS-PS and HAQ after 6 months. In contrast, VAS-pain and VAS-GH showed no relation with goal attainment. The patients' most common coping styles were active approach and comforting thoughts. <h3>Conclusion</h3> This study has raised awareness off the importance of patients goal setting. However, the goal-setting process is time consuming and, therefore, health professionals should be trained in goal setting. An online support tool which can be used in preparation for an outpatient clinic visit, can circumvent aforementioned problems. An example of such a tool is the Self-management Web, which help patients organize and prioritize perceived problems in different domains and subsequently helps them to formulate their goals. As a result patients' goals can be concretized immediately during the consultation, which can save time and, therefore, lower the threshold for implementation. Moreover, the incorporation of a feedback mechanism into a goal-setting intervention also seems to have a positive effect on goal attainment. Unfortunately, our intervention showed no effect on HRQoL. However, a general HRQoL measurement may not be sensitive or specific enough to detect change at this point. Possibly self-management and self-efficacy are better outcome measures. These may improve if patients actively address their problems in daily life, set goals to overcome them, and thereby better manage the disease. Therefore, we recommend using more specific outcomes, or qualitative assessment of outcomes, in goal setting studies. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Kim van Slingerland: None declared, Pascal de Jong Grant/research support from: Lilly, Radboud Dolhain: None declared, Annelieke Pasma: None declared.